RESULTS
We investigated medical records of 368 women who were diagnosed with PP
from 2009 to 2018. Of these, two thirds (63%) had APH, of whom 66% had
major praevia. Women with APH had greater odds of major PP (OR=2.77,
95% CI: 1.79-4.28, p <0.001). Women with APH were on
average 1.4 years younger than women without (p=0.01) (Table 1). There
was no significant difference between women with and without APH in the
mean body mass index, maternal ethnicity, maternal smoking, parity, a
history of caesarean section (CS), a history of uterine surgery, and
IVF.
< Table 1>
The percentage of emergency (both classical and lower segment) CS, and
use of general anaesthetic was greater among women with APH compared to
women without (Table 2). Compared to women without APH, women with APH
had greater risk of emergency classical CS relative to elective LSCS
(RRR=14.9, 95% CI: 3.37-66.0). Women with APH had greater odds general
anaesthetics (OR=3.14, 95% CI: 1.90-5.18), and extension of uterine
tear (OR=3.67, 95% CI: 0.44-30.81), though this did not reach
statistical significance. The median timing of delivery for women with
APH (35.4 weeks) was significantly earlier than for women without APH
(38.0 weeks) (Table 2). Women with APH had a higher median estimated
blood loss, as reflected by the IRR=1.22 (95% CI: 1.06-1.39).
< Table 2>
The percentage of medical measures was greater among women with APH
(syntocinon bolus and infusion) and lower for carbetocin, compared to
women without APH (Table 3a). Women with APH had higher odds of
syntocinon bolus (OR=1.83, 95% CI: 1.14-2.91) and infusion (OR= 1.98,
95% CI: 1.19-3.31), but lower odds of carbetocin (OR=0.27, 95% CI:
0.12-0.59). There was no association of APH with the different types of
transfusions and with a higher number of uterotonics (Table 3a).
Overall, women with APH had a higher percentage of additional surgical
techniques compared to women without, most notably for surgicell
(OR=3.43, 95% CI: 1.39-8.44) and Bakri balloon (OR=10.2, 95% CI:
1.34-78.1) (Table 3b). There were 3 women with APH and 1 without APH who
underwent hysterectomy. As expected, more packed RBCs were used for
women with APH (IRR=3.76, 95% CI: 1.96-7.21) (Table 3c). Women with APH
had slightly greater odds of any postpartum complication (OR=1.67, 95%
CI: 1.08-2.59) and longer length of post-op hospital stay (IRR=1.28,
95% CI: 1.12-1.47) (Table 4). There were no ICU admissions or maternal
deaths recorded.
< Table 3>
<Table 4>